title: [Application of intraoperative magnetic resonance imaging and multimodal navigation in surgical resection of glioblastoma].
abstract: OBJECTIVE
  To evaluate the efficacy of intraoperative magnetic resonance imaging (iMRI) and multimodal navigation in surgical resection of glioblastoma.
  
  
  METHODS
  Between February 2009 and July 2010, 76 glioblastoma patients underwent surgical resection guided by iMRI and multimodal navigation. The cohort consisted of 43 male and 33 female patients, with a mean age of 49 years (range: 14-79 years). Rates of gross total resection (GTR) and extent of resection (EoR) were calculated at first and final iMRI scans.Pearson χ(2) test was used to compare the rates of GTR.
  
  
  RESULTS
  iMRI and multimodal navigation were successfully implemented in all cases. Rates of GTR were misestimated by neurosurgeons in 24 cases (31.6%), which were confirmed by first iMRI. Total tumor resection were achieved in 20 cases (26.3%) as a result of iMRI scan, increasing the rates of gross total resection from 52.6% to 78.9% (χ(2) = 11.692, P = 0.001). Extent of resection in 28 patients who underwent further tumor resection were increased from 81.5% to 98.1%, leading to the overall extent of resection improved from 92.3% to 98.4%. At 3-month follow-up, 3 cases (3.9%) developed permanent neurologic deficits. The mean clinical follow-up was 15.6 months (range 3.0-45.0 months). The 2-year overall survival rate was 19.7%. The median progression-free survival of gross total resection group was 12 months (95% CI: 10.1-13.9 months), compared with 9 months (95%CI: 7.9-10.1 months) of the subtotal resection group (χ(2) = 4.756, P = 0.029). The overall survival of gross total resection group was 16 months (95% CI: 13.7-18.3 months), compared with 12 months (95% CI: 9.7-14.3 months) of the subtotal resection group (χ(2) = 7.885, P = 0.005).
  
  
  CONCLUSIONS
  Combined with multimodal navigation, iMRI helps maximize surgical resection of glioblastoma, preserving neurological function while increasing progression-free survival and overall survival.
authors.affiliation: Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Fang-Ye
authors.initials: FY
authors.lastname: Li
authors.forename: Xiao-Lei
authors.initials: XL
authors.lastname: Chen
authors.forename: Xiao-Yong
authors.initials: XY
authors.lastname: Sai
authors.forename: Jia-Shu
authors.initials: JS
authors.lastname: Zhang
authors.forename: Shen
authors.initials: S
authors.lastname: Hu
authors.forename: Jin-Jiang
authors.initials: JJ
authors.lastname: Li
authors.forename: Gang
authors.initials: G
authors.lastname: Zheng
authors.forename: Ting
authors.initials: T
authors.lastname: Zhang
authors.forename: Ye
authors.initials: Y
authors.lastname: Li
authors.forename: Meng-Zhuo
authors.initials: MZ
authors.lastname: Hou
authors.forename: Bai-Nan
authors.initials: BN
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D038361:Neuronavigation; D055815:Young Adult